Agenda item

To hear evidence from:

 Claire Panniker (Chief Executive) & Joe Harrison (Deputy Chief Executive)

Claire Panniker (Chief Executive) and Joe Harrison (Deputy Chief Executive) gave a presentation (attached) outlining the NMUH’s proposals for foundation Trust status and responded to questions raised by Members.  A summary of the main points to arise from this discussion is provided below.

Consultation process

·        It was noted that the NMUH is also due to consult with Overview & Scrutiny Committee at Enfield Council on the 27^th November 2007.  A copy of responses provided by NMUH to questions posed by Enfield OSC was circulated to members (attached).

·        In response to questions from the Panel, the NMUH indicated that it intended to distribute 25,000 copies of the consultation document within the Haringey and Enfield communities.  The expected response rate was difficult to predict.  Although the BEH Clinical Strategy consultation had a response rate of 2-3%, it was anticipated that the FT status consultation response would be lower as this did not directly concern changes to patient services.

·        NMUH stated that the consultation requirements for applications for Foundation Trust status concerned governance proposals for the Trust.  National policy objectives also state that all NHS Trusts are to become Foundation Trusts by end of 2008.  Consultation questions were thus focussed on those proposals for which the trust was able to respond.

Governance arrangements

·        The Panel were concerned as to how the views and opinions of the Membership would effectively be represented at Board level of the new Foundation Trust.  The Panel heard that the NMUH aims to recruit 5,000-10,000 people to the membership of the Foundation Trust from which representative Governors would be elected.  These 18 public Governors would form a majority on the Board of Governors, which itself would be able to appoint a majority of the Board of Directors (Chair & Non Execs).  The Board of Governors would be expected to engage and consult the Membership and the broader public.

·        In response to Panel questioning, the NMUH indicated that Board meetings would continue to be held in public once Foundation Trust status has been attained.

·        The Panel heard that the Board of Directors would have overall responsibility for day to day management, though the Board of Governors would have influence in the overall strategic direction of the Foundation Trust.  It is prescribed in the legislation that the Chairman of the Foundation Trust will chair both the Board of Directors and Board of Governors meetings.

Agreed: The NMUH was requested to provide an organisational chart of the new governance arrangements for the Foundation Trust (attached).

Partnerships

·        The Panel were concerned that Foundation Status might impact on partnership work in the local health economy as this would in effect take the NMUH out of NHS control.  The NMUH indicated that it would still forge close relationships with other health and social care providers, and noted that partner agencies would all be able to nominate Governors to the Board (of Governors).

Patient Experience

·        The Panel were keen to understand what impact Foundation Trust status would have on the experiences of patients using the NMUH.   The trust reported that patients would experience very little difference in the short term, though it was hoped that improved accountability arrangements would bring about substantive service improvements in the medium term.

Finance

·        NMUH has turned around a £9m deficit in to a projected surplus of £3m through efficiency savings made in 2006./7.  However, amore challenging financial climate lay ahead, as tariffs for Payment by Results would be reduced over the coming years.  

·        The main sources of income will continue to come from NHS organisations (i.e. local PCTs) once Foundation Trust status has been attained.  Income from the private patients is capped at 2002/3 levels, which for the NMUH is approximately £200,000-£300,000. The regulator, Monitor, will determine the amount which the NMUH may borrow as a Foundation Trust.  Although a number of sources (both private and public) of borrowing will be available to the NMUH once Foundation Trust status has been attained, no future lenders have not specifically identified as yet.

·        The NMUH indicated that it would be able to keep and reinvest some surpluses. The Foundation Trust would be allowed to keep any operating surplus that was derived from efficiencies made in the treatment and care of patients (i.e. improved arrangements leading to earlier discharge). Surpluses derived from unplanned variations in contracts or Service Level Agreements (i.e. seeing fewer patients to those contracted) would not be retained.

·        There was some concern among the Panel that the new financial and contractual freedoms available to the NMUH would be used to create pay differentials which may be detrimental to staff working in the locality.  The NMUH reassured the Panel that all staff would still continue to be working for the NHS.  It was acknowledged that it might be necessary to incentivise particular groups of healthcare personnel where there were known to be particular shortages or and strong competition between trusts (i.e. Consultant Radiologists).

Framework for Action

·        There was some uncertainty amongst the Panel as to how the acquisition of Foundation Trust status would affect the NMUH in relationship to the planned NHS regional reorganisation (Framework for Action – Darzi Review). 

Agreed: The NMUH was requested to provide a written response to confirm what role it would take in relation to Framework for Action (Darzi Review of London health services) and it would cooperate and respond with resultant service recommendation (attached).